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Puberty Suppression Now A Choice For Teens On Medicaid In Oregon

NPR Health Blog - Sun, 04/05/2015 - 3:37pm
Puberty Suppression Now A Choice For Teens On Medicaid In Oregon April 05, 2015 3:37 PM ET


Kristian Foden-Vencil Listen to the Story 4 min 17 sec  

Michaela leans on her mother, Dee, while talking to Dr. Karin Selva about puberty suppression.

Kristian Foden-Vencil/Oregon Public Broadcasting

Michael was born biologically male 13 years ago on the Grand Ronde Indian Reservation.

Mom, Dee, remembers buying dresses for three nieces when Michael — who now goes by Michaela — was about 6 years old.

"When she saw those dresses, her eyes just lit up. And she said, 'Who are those for?' I'll never forget it. And I said, 'Well, these are for the girls. Do you like them?' And she said, 'Yeah.' So I said, 'Well, do you want to try any of them on if any of them fit you, do you want to wear them?' And she said 'Yeah.' She just twirled and twirled in that dress — it was so wonderful."

To protect her privacy, NPR has agreed not to use Michaela or her mother's real names. That's because some kids didn't respond well when Michaela turned 7 and started experimenting with a more feminine lifestyle and clothes.

Additional Information: Read More On Oregon's Policy

Oregon began covering the cost of puberty suppression for transgender people on Medicaid in January. It also covers things like hormone therapy and reassignment surgery.

Shots - Health News In Oregon, Medicaid Now Covers Transgender Medical Care

"She wouldn't wear her pink and purple to school anymore like she used to," Dee says. "She was starting to get teased, which was way too hard for me to take."

Michaela says friends of her older brother Ray teased her.

The family decided to move to Portland when Michaela was 8 so she could live as a girl and attend a school where nobody knew any different.

When she hit puberty at 12, she turned to Karin Selva, a pediatric endocrinologist with Randall Children's Hospital in Portland.

"Any boy who wants to look like a girl can just grow your hair long and put some mascara on, put a dress on and they'll look very female," she says. "But as soon as puberty hits, that's when the body pretty much turns on someone who is transgender."

Michaela wants to transition from male to female — meaning she doesn't want to grow an Adam's apple, facial hair or a heavy male body structure. To stop that process, she now gets an injection once every three months,

"It hurts really bad," says Michaela.

Michaela has private insurance. But the medication she gets, which Medicaid in Oregon now covers, is Lupron. It costs about $7,500 for three months. A few states now cover the cost of medical treatment for people who are transgender but Oregon is one of the few that pays for drugs that suppress puberty in children who think they might want to change their gender.

Lupron has been used for years on children with precocious puberty — that is, children who start puberty too early. It's also used to treat prostate cancer and fibroid tumors. The state estimates that about 175 people will use some kind of transgender treatment under the Oregon Health Plan this year, but it doesn't have figures on how many of those people might be seeking puberty suppression.

Selva says it just gives a child more time to come to a decision about their gender identity. And once they've decided, they can start taking the hormones for the gender they'd like to be — or they can stop taking the medication and allow their body to develop unhindered.

Additional Information: LISTEN: More On Puberty Suppression What If Your Child Says, 'I'm In The Wrong Body'? 9 min 49 sec  

Dutch researchers, in a study published in the journal Pediatrics, found that puberty suppression gave transgender youth "the opportunity to develop into well-functioning young adults."

But, says Dr. Megan Bird with Legacy Medical Group in Portland, there are side effects.

"The biggest risk that we talk about is bone deposition," she says.

There's no evidence puberty suppression increases the risk of osteoporosis in later life, but there isn't much research either, and she says there are other concerns too.

"Kids who first start Lupron get headaches and hot flushes sometimes, but those are usually only for a few weeks, and then they go away," she says. "Other issues is that they're out of synch with their peers. So if you delay a kid at 12, and their peers are developing breasts and they're a late bloomer in that sense, that can be disruptive to their life as well."

Teens who completely suppress puberty are also likely to be sterile, but Bird says it's now possible to undergo a temporary puberty. It can last for just long enough to harvest sperm or eggs for later use, but not so long that a teen begins to grow sexual features, like breasts or an Adam's apple.

Dr. Ariel Smits is the medical director of the group that recommended Medicaid pay for transgender treatments in Oregon. She supported it because, she says, the medical literature is clear: hormone therapy, surgeries and puberty suppression help people live happier lives.

"People with gender dysphoria that did not receive treatment had a much higher rate of hospitalizations or ER visits or doctors visits for depression and anxiety, and they had a pretty significantly high suicide rate. Some studies found about 30 percent," she says.

When people get treatment, she says, those rates drop to a level much closer to that of the general population.

This story is part of a reporting partnership with NPR, Oregon Public Broadcasting and Kaiser Health News.

Copyright 2015 Oregon Public Broadcasting. To see more, visit
Categories: NPR Blogs

In Rural Virginia, Truckers Can Stop For Coffee And A Physical

NPR Health Blog - Sun, 04/05/2015 - 9:54am
In Rural Virginia, Truckers Can Stop For Coffee And A Physical April 05, 2015 9:54 AM ET


Sandy Hausman Listen to the Story 3 min 47 sec  

Crystal Groah holds four-month-old son Brently while Dr. Rob Marsh examines him. He and his twin sister Savannah were premature at birth, but with care from Marsh both are doing well.

Sandy Hausman/WVTF

Rob Marsh has a medical practice in Virginia's Shenandoah Valley. He likes the freedom to open his office at night if a patient gets sick.

Marsh wants to make house calls, and he needs to pay a staff that has grown from 2 to 23. But many people in this area lack insurance.

"You've got to make budget to make payroll," he says.

The financial pressures of practicing medicine in the 21st century have led more doctors to take jobs with large hospitals and medical practices. Last year, only 17 percent of doctors were in solo practice.

Wanting to stay put, but feeling the budget pressure, Marsh decided to add a new source of revenue from a surprising source of patients.

About 20,000 truckers pass through Raphine, Va., every day, and the owner of White's Truck Stop asked Marsh to open an office there. At first, the busy country doctor refused.

"But then as I talked to him more, and I looked at it, I realized this may be a good source of additional income for us, so that if I don't want to charge somebody else, I can do that from doing physicals on truck drivers," he says.

So Marsh remodeled a one-story brick building next to White's Truck Stop and opened up an office.

"There are five or six truck stops in the nation that have medical care," he says. "I went to two of them; they were trailers that were parked at a truck stop. I wanted to establish a practice that you would be proud to go to if you were a professional."

Truckers like Christopher Sims of Blountsville, Ala., love the convenience. Sims, 44, has had a virus for several days, but he's got a delivery to make and he can't pull his big rig loaded with new cars into the parking lot of a local urgent care.

"Been sick for three days, so I said, 'Hey, I'm going to stop and check it out,' " Sims says.

Marsh accepts walk-ins who complain of backaches from sitting long hours behind the wheel, injuries suffered while hooking trucks to cabs and headaches caused by endless traffic jams. Marsh says today's trucker is more health-conscious than in decades past, but driving is sedentary, stressful work.

Some patients should be monitored for ongoing medical problems or a risk of recurrence. Sims, for example, was once diagnosed with lymphoma.

"I was told I had two to three months to live 13 years ago, and I told them I'd beat it, and I did — so here I am," he says.

Now that he's found Marsh, Sims says he might make this a regular stop. Marsh says there others who consider him their family doctor.

"There is a significant percentage of truck drivers — I've heard anywhere from 15, 20 percent — that their truck is their home," he says. "So they don't have a home doctor, and we're becoming that. They know that they come through this truck stop once a week or twice a month or whatever, and that we'll be here for them."

Office manager Linda Helmech says she and the other support staff are happy to treat these ailing road warriors.

"They're always very nice," Helmech says. "You ask them where they've come from, and they're always very excited to talk to someone, because I know that's a lonely job. It's enjoyable, because like I say, they're not at home with their families."

Sims gets some medication and is back on the road, hoping to make it to Silver Spring, Md., by the afternoon. The next time he stops for medical care, he'll find another service to keep him in good health: The truck stop plans to add a full-service pharmacy.

Copyright 2015 WVTF Public Radio. To see more, visit
Categories: NPR Blogs

When It Comes To Insurance, Mental Health Parity In Name Only?

NPR Health Blog - Sat, 04/04/2015 - 6:11pm
When It Comes To Insurance, Mental Health Parity In Name Only? April 04, 2015 6:11 PM ET

Partner content from

Jenny Gold NPR Staff Listen to the Story 4 min 33 sec  

Mental health care advocates say patients face challenges in insurance coverage.


By law, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes care. But advocates say achieving this mental health parity can be a challenge. A report released earlier this week by the National Alliance on Mental Illness found that "health insurance plans are falling short in coverage of mental health and substance abuse conditions."

Reporter Jenny Gold of Kaiser Health News tells NPR's Arun Rath that patients are still having trouble getting their care covered. In this interview, she outlines some of the issues confronting both patients and the insurance industry.

Interview Highlights

Currently, insurers adhering to parity rules is a mixed bag.

Insurance companies used to have a separate deductible or higher copay for mental health or substance abuse visits. That's sort of gone away. For the most part, insurers really have complied. Right now, there really isn't a separate deductible for mental health and there isn't a higher copay, so on that side, you know, they really have complied. But on another sort of subtler and harder-to-pinpoint side, advocates are saying they're really not complying.

Insurance companies, in order to keep down costs, they will do things called "medical necessity" review. Basically, they look at someone's care and ask is it really medically necessary. And advocates say they're applying those sorts of cost-control techniques way more stringently on the mental health side and the substance abuse side than they are on the physical health side. So people are still having trouble getting their care covered.

Insurers say it's complicated to distinguish between physical and mental health

Insurance companies are arguing this is a really hard law to implement. I spoke with Clare Krusing from America's Health Insurance Plans, which is the insurance industry's main trade group, and she says they're really doing their best to make this work:

"The plans have taken tremendous steps since the final rules came out to implement these changes and requirements in a way that is affordable for patients and again this goes back to the fact that we are at a point where health care costs continue to go up."

She also said that it's hard to compare mental and physical health, that those are two really different things, sort of apples and oranges, and it's hard to make them exactly equal when treatment often doesn't line up and success can be harder to measure on the mental health side.

Patients still report ongoing challenges

Advocates, patients, lawyers alike say it's not going well for patients and that we've got something that looks like mental health parity in name only. The National Alliance on Mental Illness polled their consumers and found out that consumers said they were twice as likely to get their mental health care denied than medical care, which suggests that insurance companies still aren't sort of judging whether care ought to be given equally between the two.

I spoke with Carol McDaid, an advocate who runs the Parity Implementation Coalition. She's got a helpline where she takes consumer complaints from people who say they're still having trouble getting their care covered:

"They end up with this perception that they have access to care, but when they're in a crisis for themselves or their loved one, lo and behold, the care's not available because of these cost-control techniques."

It's really hard for people to bring a complaint. In order to prove there's been a violation, you actually have to look at how an insurance company makes decisions on the mental health side and then compare it to how they make determinations on the medical, surgical side. And insurance companies aren't even willing often to give up those documents to be analyzed.

In addition, for a consumer to make a complaint, it means they have to come forward and admit on some level that they have a mental illness. There's still a lot of stigma about these conditions and sometimes it's hard for people to step forward. Especially when it means telling their employers that they have some kind of illness.

A few states are taking action

There are a handful of states that really are taking some enforcement actions, including New York, which has made some settlements with insurance companies, and California — and also, quite a few individual and class action lawsuits against insurance companies alleging that they are violating mental health and substance abuse parity law. And so that may end up being the way it sort of starts getting enforced.

Copyright 2015 Kaiser Health News. To see more, visit
Categories: NPR Blogs

California Faith Groups Divided Over Right-To-Die Bill

NPR Health Blog - Fri, 04/03/2015 - 5:03pm
California Faith Groups Divided Over Right-To-Die Bill April 03, 2015 5:03 PM ET


Pauline Bartolone Listen to the Story 3 min 55 sec  

The Rev. Vernon Holmes leads a Lutheran congregation near Sacramento, Calif., that supports the state's right-to-die bill. He describes his faith as promoting quality of life.

Andrew Nixon/Capital Public Radio

Clergy, more than a lot of people, come face to face with death regularly.

The Rev. Vernon Holmes, for example, leads a Lutheran congregation near Sacramento; the average age of members is 79.

His faith promotes quality of life, Holmes says. And that same faith leads him to challenge the status quo and injustice. His congregation belongs to an advocacy group called California Church Impact, which supports California's bill that would allow the terminally ill to end their own lives with medical assistance.

The state is one of nearly 20 with right-to-die legislation under consideration this year. The measures would legalize prescriptions to speed dying for terminally ill patients.

"There are things in life that are worse than death," Holmes says.

His experience as a founding member of a regional hospice program for the terminally ill helped him come to that conclusion, he says. The people he encountered didn't fear dying as much as losing independence, being a burden or living in constant pain. His faith, he says, is about supporting people to live free and productive lives.

"When that's no longer possible, and they feel that their life has come to a point of closure, and they are in the process of dying, to have some say in that process, seems to be the more just approach," he says.

Additional Information: Shots - Health News Doctors With Cancer Push California To Allow Aid In Dying Intelligence Squared U.S. Debate: Should Physician-Assisted Suicide Be Legal? Shots - Health News Contemplating Brittany Maynard's Final Choice

Peggy Rheault, a 76-year-old member of Holmes' congregation, says she's come to a similar conclusion.

"I don't think Jesus would want us to suffer," Rheault says. "I think he would agree with us. To me it's not suicide — it's help."

But Ned Dolejsi, from the California Catholic Conference, a legislative advocacy group that represents the state's Catholic bishops, takes a different view. The legislation now under consideration in California doesn't protect or respect the most vulnerable, he says.

Catholics believe suffering is part of life, Dolejsi says, and that the challenge is to transform that suffering. If people are in pain when they're dying, he believes, they're probably getting bad medical care.

"That's a challenge we should all be addressing as a society," Dolejsi says. "Not saying 'Oh, because there is this pain ... then we have to allow someone to separate themselves from the rest of us, and to take their own life.' "

Instead, he says, society should focus on, "How do we make sure no one dies in pain, and no one dies alone?"

Many Christian denominations officially oppose physician-aided dying. But Peg Sandeen of the Death with Dignity National Center says that on an individual level, people of faith have long supported the cause.

"Death with dignity is absolutely compatible with Christian views," she says. "It's about compassion. It's about love; it's about family. And those seem to be deeply held Christian values."

Faith is only one cause for debate around California's End of Life Option Act. There's a long list of groups weighing in — pro and con — as the bill travels through the Legislature.

Copyright 2015 Capital Public Radio. To see more, visit
Categories: NPR Blogs

Men And Women Use Different Scales To Weigh Moral Dilemmas

NPR Health Blog - Fri, 04/03/2015 - 2:52pm
Men And Women Use Different Scales To Weigh Moral Dilemmas April 03, 2015 2:52 PM ET Poncie Rutsch Todd Davidson/Getty Images/Illustration Works

You find a time machine and travel to 1920. A young Austrian artist and war veteran named Adolf Hitler is staying in the hotel room next to yours. The doors aren't locked, so you could easily stroll next door and smother him. World War II would never happen.

But Hitler hasn't done anything wrong yet. Is it acceptable to kill him to prevent World War II?

This is one moral dilemma that researchers often use to analyze how people make difficult decisions. Most recently, one group re-analyzed answers from more than 6,000 subjects to compare men's and women's responses. They found that men and women both calculate consequences such as lives lost. But women are more likely to feel conflicted over what to do. Having to commit murder is more likely to push them toward letting Hitler live.

"Women seem to be more likely to have this negative, emotional, gut-level reaction to causing harm to people in the dilemmas, to the one person, whereas men were less likely to express this strong emotional reaction to harm."

"Women seem to be more likely to have this negative, emotional, gut-level reaction to causing harm to people in the dilemmas, to the one person, whereas men were less likely to express this strong emotional reaction to harm," Rebecca Friesdorf, the lead author of the study, tells Shots. A master's student in social psychology at Wilfrid Laurier University in Waterloo, Ontario, Friesdorf analyzed 40 data sets from previous studies. The study was published Friday in the Personality and Social Psychology Bulletin.

Every question in the study had two scenarios, each with slightly different consequences in order to tease out different ways of thinking about the dilemma. Some people are motivated by consequences, weighing costs and benefits to make a decision. Others dwell on the act of killing Hitler, because it defies moral norms. Philosophers would label the first group as utilitarians, and the second group as deontologists. The latter are more likely to let Hitler live.

One hypothetical dilemma replaces Hitler with a man who abducts a child and holds her ransom for a week, because both philosophies would support letting the kidnapper live. Killing him defies the moral norm, so a person motivated by social norms will let him live. And killing him won't save any lives, so a person motivated by consequences would argue that the costs outweigh the benefits, and let him live as well.

13.7: Cosmos And Culture Being Good Isn't Zero Sum

Every dilemma is different, which is why the researchers used 10 scenarios. The Hitler example relies heavily on time travel, but Friesdorf worries that people won't respond properly unless they fully accept time travel. If they assume that time travel is impossible, then killing Hitler becomes irrelevant. There's a similar problem with self-interest – whether the person asked is in immediate danger. A person might be more willing to torture a prisoner if he or she is in immediate danger.

Friesdorf says that she finds the "Hard Times" dilemma to be one of the most interesting. It reads:

"You are the head of a poor household in a developing country. Your crops have failed for the second year in a row, and it appears that you have no way to feed your family. Your sons, ages 8 and 10, are too young to go off to the city where there are jobs, but your daughter could fare better.

"You know a man from your village who lives in the city and who makes sexually explicit films featuring girls such as your daughter. In front of your daughter, he tells you that in one year of working in his studio, your daughter could earn enough money to keep your family fed for several growing seasons.

"Is it appropriate for you to employ your daughter in the pornography industry in order to feed your family?"

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"Very few people say yes you should do it, even though it will save the rest of the family," says Friesdorf.

She also analyzed a small subset of the data in which each subject reported how difficult it was to choose a course of action. Women tended to find it more difficult to decide, and Friesdorf hypothesizes that this is because they feel more conflict between weighing benefits and harms versus following society's moral rules.

"Women seem to be feeling more equal levels of both emotion and cognition. They seem to be experiencing similar levels of both, so it's more difficult for them to make their choice," she says.

Even though the dilemmas seem far-fetched, Friesdorf says we encounter less dramatic variations of them all the time.

For instance, a manager might need to make an employment decision that would weigh the future of one person against the fate of a group. "If these [gender] differences also hold in that context, then that could have some implications for how women and men are making those decisions," she says.

Copyright 2015 NPR. To see more, visit
Categories: NPR Blogs

Will Smart Clothing Amp Up Your Workout?

NPR Health Blog - Fri, 04/03/2015 - 10:53am
Will Smart Clothing Amp Up Your Workout? April 03, 201510:53 AM ET


Christina Farr

Athos workout wear includes sensors that measure muscle activity.

Tim Mantoani/Courtesy of Athos

When Eric Blue goes to the gym, he sports a wafer-thin shirt that tracks his every move.

Blue's shirt contains tiny sensors woven into the fabric. They monitor his heart rate, the calories he burns and other metrics, like breathing rate. A companion app on his smartphone informs him about the intensity of his workouts.

Blue, a Los Angeles entrepreneur, says regular use of the shirt has pushed him to "up his game" during exercise.

This is no ordinary shirt. It represents the evolution of the wearable-tech trend from accessories, like watches and bands like Fitbits, to clothing.

Blue, 38, was among the first people to buy a biometric shirt from the Montreal-based startup Hexoskin. Blue is a self-professed "fitness junkie" who goes to the gym at least five times each week, so he said the shirt is worth the $399 price tag. For Blue, it's far easier to throw on a Hexoskin shirt and go, rather than fiddle with a smartphone or chest strap.

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"My old heart rate monitor is now sitting in the closet, gathering dust," he said. "It sounds very sci-fi right now, but in the future all of the personal data being collected by health and fitness sensors and smart watches will alternatively be readily available in our clothing."

Blue isn't alone in embracing smart clothing.

Athletes, astronauts and Cirque du Soleil performers have espoused the benefits of using Hexoskin and other smart clothing products. Smart shirts, athletic pants and socks started hitting stores last year.

But medical experts say they hope patients with serious or chronic medical conditions also can benefit from smart clothing.

"These companies will hit fitness fans first," said Stephanie Tilenius, founder of Vida, a mobile app that matches sick patients with personal health coaches. "But I see huge potential for chronic care."

It's still early for smart clothing, but the technology is evolving rapidly.

One company, Athos, based in Redwood City, Calif., is developing garments that can track people's muscle activity. Sensors can detect how hard muscles are working and whether a user is putting too much pressure on one side of the body, for instance.

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Athos is focused on reaching passionate exercisers who want to make improvements to their exercise regimes, said CEO Dhananja Jayalath. "The people who buy our stuff are into fitness — they typically spent a lot of time working out."

As is the case with many startups, Jayalath started Athos to solve a personal problem.

He came up with the idea while studying electrical engineering in college. Jayalath, who frequently goes to the gym, said he couldn't stop thinking about whether technology could replace a personal trainer.

"After we came up with the idea, people told us we were crazy and it wasn't possible," he said.

It took Jayalath and a fellow electrical engineer five years to build a working prototype. The apparel can track muscle activity, heart rate recovery times and breathing rates. In the past, athletes would have needed to be hooked up to a machine in a performance lab to access all this information.

Like the Hexoskin apparel, these products won't come cheap. Athos shorts or shirts will cost $99 each, and will require a $199 sensor that fits in a pocket on the garment.

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Although Jayalath didn't intend the products to be used for sick people, Athos has already received interest from the medical community.

The company anticipates that its clothing will eventually be used in clinical settings such as hospitals and rehabilitation clinics. Smart clothing could benefit patients with a variety of medical conditions, including heart disease and obesity.

"Gradually over the next few years, these low-cost, consumer-focused, data-rich devices and apps will bring to bear vastly more data than physicians have in some circumstances," said Pete Moran, a general partner at the venture capital firm DCM, which invested in Athos.

"Fitness shirts could find a market in rehabilitation and could facilitate home exercises. That's just a thought," said Dr. Molly Maloof, a general practitioner based in San Francisco who has been closely following the wearable tech trend.

But selling wearables as medical devices comes with strings attached.

Shots - Health News Sure You Can Track Your Health Data, But Can Your Doctor Use It?

"It would be far easier for a product like this to remain in the 'wellness' category," said Morgan Reed, executive director at The App Association, a Washington, D.C., nonprofit that works with patient advocates and app developers.

By saying they are helping to improve fitness and wellbeing, Reed said, these companies may hope to avoid stricter regulatory oversight as medical devices by the Food and Drug Administration.

And many physicians are not convinced that the data these devices gather is reliable enough to be used for patient care. This mistrust doesn't just apply to smart clothing, but the wearable-tech trend in general.

"There has been an explosion in patient-generated data, but much of it may not be useful to physicians in the short-term," said Dr. Pat Basu, chief medical officer at Doctor On Demand, an app that connects people to doctors.

"If a patient is showing me their blood pressure or heart rate they gathered from an app or device, I'll always ask myself, 'Is the fidelity of this information accurate or not?' " Basu says.

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Wearable-tech makers should produce reports about each patient that doctors and nurses can skim, Basu says. Many physicians are already inundated with the wealth of data that patients are generating from new wearable apps and devices, he said.

Moreover, some doctors fear that they will be liable if they miss something in the growing pile of patient data.

Privacy is another concern. The App Association's Reed says he's satisfied that patient's sensitive health information is protected – for now.

But Reed expressed fears that the next crop of smart clothing companies might opt to offset the high cost of their products by selling people's health data to pharmaceutical companies, insurance providers and even employers.

"Would consumers understand that they're buying the version that is monetizing through data sharing?" Reed said. "That's the problem that everyone in the wearables industry is working on right now."

Copyright 2015 KQED Public Media. To see more, visit
Categories: NPR Blogs

Will Your Child Become Nearsighted? One Simple Way To Find Out

NPR Health Blog - Thu, 04/02/2015 - 1:10pm
Will Your Child Become Nearsighted? One Simple Way To Find Out April 02, 2015 1:10 PM ET

You really should go out and play. But I can't blame the TV for your nearsightedness.

FPG/Getty Images

This is for everyone whose parents said, "Sitting too close to the TV is going to ruin your eyes." In other words, pretty much all of us.

Sitting too close to the TV doesn't predict nearsightedness, according to a study that tracked the vision of thousands of children over 20 years. Nor does doing a lot of close work.

Instead, as early as age 6 a child's refractive error — the measurements used for an eyeglass prescription — best predicts the risk.

One-third of adults are nearsighted, and the problem typically develops between ages 8 and 12.

Children are not great about telling parents that they can't see the board in class, and the letter-chart screening tests used by schools and pediatricians are less than ideal, according to Karla Zadnik, dean of the College of Optometry at Ohio State University and lead author of the study. It was published Thursday in JAMA Ophthalmology.

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"Just measuring how well they can read the chart won't capture that key piece of information," she says.

Zadnik began the study in California back in 1989, expanding it to include almost 5,000 ethnically diverse children around the United States. The children's eyes were measured regularly, and parents were quizzed on health and habits.

In this analysis, the researchers looked at 13 potential risk factors for nearsightedness, or myopia.

Having nearsighted parents increases the risk for myopia, the study found, but it's not as strong a predictor as is refractive error. Doing close work or watching TV close up weren't risk factors.

Earlier work by this group found that children who spent more time outdoors were less likely to be nearsighted, but it's unclear why that would be. One theory is that being exposed to sunlight or higher vitamin D levels could make a difference. The study was funded by the National Institutes of Health.

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In the study, children whose refractive error was less than +0.75 diopters (which is slightly farsighted) in first grade were most likely to become nearsighted. As a child gets older that number drops, so that by sixth grade a child with no refractive error is at risk. Myopia is defined as a refractive error of -0.75 diopters or more.

Optometrists and ophthalmologists measure refractive error by changing lenses in front of a patient's eye and asking, "Which is better, 1 or 2?"

There's no way to prevent nearsightedness, but finding out if children are at risk could make it more likely that they'll not go through a year of school squinting at the board, Zadnik says.

"A parent might say, 'Oh, my child is at high risk, I want to be sure he's getting regular eye examinations,' " she says.

Children's eye exams are required to be covered under the Affordable Care Act, but the states differ on just what they're covering, so it pays to check.

Talking with Zadnik, you get the sense that she's happy to debunk some of those parental admonitions.

"I had a grandfather who was an optometrist," she says. "He used to tell me that at the end of every page I should look up at something across the room. I am very nearsighted."

Copyright 2015 NPR. To see more, visit
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Searching Online May Make You Think You're Smarter Than You Are

NPR Health Blog - Thu, 04/02/2015 - 9:52am
Searching Online May Make You Think You're Smarter Than You Are April 02, 2015 9:52 AM ET Poncie Rutsch Stuart Kinlough/Getty Images/Ikon Images

Using the Internet is an easy way to feel omniscient. Enter a search term and the answers appear before your eyes.

But at any moment you're also just a few taps away from becoming an insufferable know-it-all. Searching for answers online gives people an inflated sense of their own knowledge, according to a study. It makes people think they know more than they actually do.

"We think the information is leaking into our head, but really the information is stored somewhere else entirely," Matthew Fisher, a doctoral student in cognitive psychology at Yale University, tells Shots. Fisher surveyed hundreds of people to get a sense of how searching the Internet affected how they rate their knowledge. His study was published Tuesday in the Journal of Experimental Psychology: General.

Fisher began with a simple survey: he asked questions such as "How does a zipper work?" or "Why are there leap years?" He allowed just half of his subjects to use the Internet to answer the questions.

13.7: Cosmos And Culture What If Web Search Results Were Based On Accuracy?

Then he asked the subjects to rate how well they thought they could answer a question unrelated to the first question, such as "Why does Swiss cheese have holes?" or "How do tornadoes form?" People who had been allowed to search online tended to rate their knowledge higher than people who answered without any outside sources.

To reveal factors that might explain why the Internet group rated their knowledge higher, he designed follow-up experiments using different groups of people. First, he asked people to rate their knowledge before the test; there was no difference between subjects' ratings. But afterwards, the Internet-enabled subjects again rated their knowledge better than the others.

Next, Fisher tried to make sure that people saw the exact same information. He told the Internet-enabled group, "Please search for the page with this information." The non-search group was sent directly to the page. Fisher checked that the two groups used the same URL. Still, the people who could actively search rated their knowledge higher than those who simply saw the information.

And this is just a taste of the experiments Fisher ran. He also:

  • Compared different search engines.
  • Reworded his questions to make it clear that he was asking for only the subjects' knowledge, not the Internet's.
  • Made the online searchers use filters that would keep any relevant results from showing up.
  • Asked questions for which there were no answers online, such as "How do wheat fields affect the weather?"
  • Asked people to choose one of seven brain scans that most resembled their brain. The people who had been searching online picked the image with the most activity.

The results kept coming back the same: searching online led to knowledge inflation.

There are practical consequences to this little exercise. If we can't accurately judge what we know, then who's to say whether any of the decisions we make are well-informed?

"People are unlikely to be able to explain their own shortcomings," says Fisher. "People aren't aware of the quality of explanation or the quality of arguments they can produce, and they don't realize it until they encounter the gaps."

Monkey See This Is (Not) The Most Important Story Of The Year

The more we rely on the Internet, Fisher says, the harder it will be to draw a line between where our knowledge ends and the web begins. And unlike poring through books or debating peers, asking the Internet is unique because it's so effortless.

"We are not forced to face our own ignorance and ask for help; we can just look up the answer immediately," Fisher writes in an email. "We think these features make it more likely for people to consider knowledge stored online as their own."

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Germanwings Crash Highlights Workplace Approaches To Mental Health

NPR Health Blog - Wed, 04/01/2015 - 6:03pm
Germanwings Crash Highlights Workplace Approaches To Mental Health April 01, 2015 6:03 PM ET Listen to the Story 3 min 47 sec  

When it comes to an employee's mental health status, what does an employer need to know, or have a right to know?


The horrifying crash last week of the Germanwings flight operated by Lufthansa has put a spotlight on what the airline knew — and what it should, or could have done — about its pilot's mental health.

Lufthansa could face unlimited liability, after the pilot allegedly brought the plane down deliberately. Here in the U.S., employment experts say monitoring employees' mental health status raises a thicket of complicated issues.

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According to the Air Line Pilots Association, most U.S. pilots undergo medical testing that includes mental and emotional assessment at least once a year by a doctor approved by the Federal Aviation Administration. The airline industry association says crew members' fitness for duty can also be tested, as warranted.

But it's not just airlines with this concern. And when it comes to an employee's mental health status, what does an employer need to know, or have a right to know?

"It's a very complicated issue," says employment attorney Jonathan Segal, of Duane Morris Institute in Philadelphia. He says employers must respect health privacy and discrimination laws in addressing their potential workplace or public safety concerns.

"We're balancing," he says, "and anytime you're balancing, you're playing in the gray."

Segal advises employers: When in doubt, evaluate it — even at the risk of facing a discrimination charge down the line.

"Is there a risk in having an evaluation? Yes," Segal says. "Is there risk in not having an evaluation? Yes. So, if you have objective facts and you say, 'We're not saying you are a risk; we're not saying you're not. We just want you to be evaluated,' I think you're in a prudent position."

But evaluating mental health problems is not clear-cut, says Alan King, chief operating officer of Workplace Options, a firm that manages workplace benefits for companies around the world. For instance, he says, there are drug tests for those with substance abuse, but, "that doesn't exist for mental health."

The Americans with Disabilities Act prohibits employer discrimination against people with disabilities, including mental health problems. The statute is written in a way that gives employers some flexibility to monitor for potential problems, says Christopher Kuczynski, assistant legal counsel for the Equal Employment Opportunity Commission.

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"Once somebody gets on the job, under the ADA, generally the rule is you can ask medical questions and you can require people to undergo medical examinations only in certain circumstances," says Kuczynski. "Only where it's what we call 'job-related and consistent with business necessity.' "

Kuczynski says that airlines and other organizations responsible for jobs that affect public safety — those in trucking or law enforcement, for example — can require such evaluations of their employees, so long as the evaluation is done for everyone in that particular job.

And in any industry, there are instances where security trumps workers' rights, says Deirdre Kamber Todd, an employment lawyer in Allentown, Pa.

"The employer does not have to keep somebody in their workplace [if] they reasonably believe that that person may constitute a danger," she says.

The vast majority of people with mental health problems pose no danger. But some fear last week's airline crash could make it more difficult to reach out to those with psychological problems.

"The concern is that there's too much of a backlash when a case like this occurs," says Ron Honberg, an attorney and director of public policy and legal affairs for the National Alliance on Mental Illness. "It may serve as a deterrent to people seeking help, and that would be counterproductive."

Especially, Honberg says, if these employees think they might lose their jobs. Also, he points out, assessing a co-worker who may be going from "depressed" to "dangerous to themselves or others" is highly subjective.


The crash last week of the Germanwings flight has put a spotlight on what the airline knew and what it should or could have done about its pilot's mental health. Parent company Lufthansa and its insurer could face unlimited liability because the pilot allegedly brought the plane down deliberately. In the U.S., employment experts say monitoring the mental health status of employees raises a number of complicated issues. NPR's Yuki Noguchi reports.

YUKI NOGUCHI, BYLINE: According to the Airline Pilots Association, most U.S. pilots undergo medical testing that includes mental and emotional assessment at least once a year by a Federal Aviation Administration approved doctor. The Airline Industry Association says crew members fitness for duty can also be tested as warranted. But it's not just airlines with this concern, and when it comes to employee's mental health status, what does an employer need to know or have a right to know?

JONATHAN SEGAL: It's a very complicated issue.

NOGUCHI: Employment attorney Jonathan Segal says employers must respect health privacy and discrimination laws in addressing their potential workplace or public safety concerns.

SEGAL: We're balancing, and anytime you balance, you're playing in the gray.

NOGUCHI: Segal tells employers, when in doubt, evaluate the person, even at the risk of facing a discrimination charge down the line.

SEGAL: If there a risk in an evaluation? Yes. Is there a risk in not having an evaluation? Yes. So if you have objective facts and you say, we're not saying you are a risk, we're not saying you're not, we just want you to be evaluated by someone, I think you're in a prudent position.

NOGUCHI: But evaluating mental health problems is not clear-cut says Alan King, CEO of Workplace Options, which manages workplace benefits for companies. For instance, he says there are drug tests for those with substance abuse, but...

ALAN KING: ...That doesn't exist for mental health.

NOGUCHI: The Americans With Disabilities Act prohibits employer discrimination against people with disabilities, including mental health problems. The statute is written in a way that gives employers some flexibility to monitor for potential problems, says Christopher Kuczynski, assistant legal counsel for the Equal Employment Opportunity Commission.

CHRISTOPHER KUCZYNSKI: Once somebody gets on the job under the ADA, generally the rule is you can ask medical questions and you can require people to undergo medical examinations only in certain circumstances - only where it's what we called job-related and consistent with business necessity.

NOGUCHI: Kuczynski says jobs besides airlines affecting public safety - trucking or law enforcement, for example - can require such evaluations so long as the evaluation is done for everyone in that job. And in any industry, there are instances where security trumps workers' rights, says Deirdre Kamber Todd, an employment lawyer.

DEIRDRE KAMBER TODD: The employer does not need to keep somebody in their workplace where they reasonably believe that that person may constitute a danger.

NOGUCHI: The vast majority of people with mental health problems pose no danger, but some fear last week's airline crash could make it more difficult to reach out to those with psychological problems. Ron Honberg is director of public policy for the National Alliance On Mental Illness.

RON HONBERG: The concern is if there's too much of a backlash when a case like this occurs, it may actually serve as a deterrent to people stepping up and seeking help when they need it. And that would be counterproductive.

NOGUCHI: Especially, he says, if they think they might lose their jobs. Yuki Noguchi, NPR News, Washington.

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Trading Walkathons For Ice Buckets, Charities Try To Hold On To Donors

NPR Health Blog - Wed, 04/01/2015 - 4:32pm
Trading Walkathons For Ice Buckets, Charities Try To Hold On To Donors April 01, 2015 4:32 PM ET Listen to the Story 4 min 4 sec  

A big crowd turned out for the March of Dimes walkathon in Gainesville, Fla., in early March. But overall, the March of Dimes' March for Babies raised $3.5 million less in 2014 than it did the year before.

Elizabeth Hamilton/Gainesville Sun/Landov

Springtime means outdoor charity events, and there are plenty to choose from.

You can walk, run, bike, swim or even roll around in the mud to raise money for a cause. But some of the bigger, more established events aren't doing as well as they used to, and charities are trying to adjust.

Last year, the 30 largest walkathons and similar events raised $41 million less overall than they did the year before, according to a recent study by the Peer to Peer Professional Forum, a group for professionals who organize fundraising events.

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"These would be programs like the American Cancer Society's Relay for Life, which brought in $335 million, but they were down $45 million last year," says David Hessekiel, the forum's president. He also notes that the March of Dimes' March for Babies raised $3.5 million less than it did the year before and fell below $100 million in receipts for the first time in years.

Hessekiel says these events still raise large amounts of money, but they're facing competition from a growing number of fundraisers.

He says individual donors today are also looking for more control and flexibility than being required to show up on a particular Saturday morning for a walk.

"In the era we live in, everyone has the opportunity to do what they'd like to, on their own time pretty much," Hessekiel says, and link to it with the online tools that are available."

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There's no greater example of this fundraising trend than last year's ice bucket challenge, which raised cash for the ALS Association and other groups fighting amyotrophic lateral sclerosis, or Lou Gehrig's disease. Just about everyone on the planet seemed to throw cold water on his or her head — raising more than $220 million.

Hessekiel points to other increasingly popular fundraising events, like people shaving their heads for childhood cancer research, or growing a mustache for men's health.

The dramatic shift in styles of fundraising, and their relative effectiveness, aren't lost on Sandra Hijikata, a senior vice president at the Juvenile Diabetes Research Foundation, which saw a 12 percent drop last year in its receipts from walkathons.

"There's huge competition," Hijikata says. "So it's important for an organization like JDRF to make sure that people understand who we are — that they understand the important work that we do."

So her diabetes group is re-branding its walking events. Each event is now called One Walk, to make clear that participants are raising money for Type 1 diabetes. Hijikata says the charity is also doing more to engage families affected by the disease in the effort and offering do-it-yourself options for those who prefer not to walk or bike.

"We provide electronic support, websites, etc., and they can design what they want to," she says, noting one online campaign where donors are cracking eggs on their heads in memory of a friend who had diabetes.

This doesn't mean that walkathons are going away.

Christie Madsen, senior manager of national events and brand campaigns for Make-A-Wish America, says her group plans to hold even more of its Walk for Wishes events in the future. She says the walks not only raise money but generate enthusiasm for the cause, which is granting the wishes of children who have life-threatening illnesses.

"What we see is a huge opportunity for growth," she says.

Like other charities, her group is trying to do more to help local chapters get the most out of the walks, in part by turning participants into better fundraisers. They're providing them with more support, such as tips on the best way to ask family and friends for money.

Mimi Totten says that was the hardest part for her, when she decided to participate in a recent Make-A-Wish Foundation walk in Fairfax, Va.

"Oh, my goodness," Totten says. "I would rather lick the kitchen floor than ask for money. And for months, I agonized over it and I couldn't write the letter."

But she finally sent out a fundraising email to family and friends and was pleasantly surprised by the response. She and her friend Kathy Young were able to raise about $5,000 for the foundation.

They're now considering new things they can do — maybe a wine and cheese party for friends — to raise even more money next year.

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Diagnosing A Sinus Infection Can Be A DIY Project

NPR Health Blog - Wed, 04/01/2015 - 3:11pm
Diagnosing A Sinus Infection Can Be A DIY Project April 01, 2015 3:11 PM ET

This is what the inflammation of sinus infection looks like in a false-color X-ray. It hurts even more in real life.

CNRI/Science Source

Sinus infections are miserable, and it's hard not to want to run to the doctor for relief. Rethink that, the nation's ear, nose and throat doctors say.

Most people who get sinusitis feel better in a week, the doctors say, and many of those infections are caused by viruses. Getting an antibiotic isn't going to help.

Shots - Health News Got A Sinus Infection? Antibiotics Probably Won't Help

So the ENTs want to get patients involved in figuring out what's causing the infection, partly to reduce needless use of antibiotics and also so that people who might benefit from medication will get it.

"For the first time we've really made it crystal clear how to self-diagnose your own bacterial sinus infections without going to the doctor, with a high degree of accuracy," says Dr. Richard Rosenfeld, lead author of the practice guidelines published Wednesday by the American Academy of Otolaryngology-Head and Neck Surgery Foundation.

OK, how can you tell if it's bacterial or viral?

  • If you've been sick for less than 10 days and you're not getting worse, it's almost certainly viral.
  • If you're not improving at all in 10 days or if you get worse in that 10 days after having improved a bit, bacteria are probably to blame.

Underlying this DIY approach is the notion that it's OK to wait and see what happens, rather than hastening to get antibiotics.

Even if it is bacterial, Rosenfeld says, antibiotics help just a tiny bit. "Most of what's going on is your body fighting off the infection yourself with maybe a little boost from antibiotics."

Shots - Health News Doctors Say It's OK To Wait Before Treating Kids' Sinus Infections

Sinusitis gets diagnosed 30 million times a year, and with the infections accounting for 20 percent of all antibiotic prescriptions, the ENTs see this as a chance to reduce overprescribing.

They're going further than their previous guidelines in saying that even if you're really sick, it's OK to wait on the meds. And they're breaking ranks with their fellow physicians in infectious disease and internal medicine, who say everyone with a bacterial infection should get an antibiotic.

"We're not saying you're wrong to do it," Rosenfeld says. "We're saying, you know, there's a good chance you're going to get better on your own."

So then what to do while you're feeling like your head is going to explode?

Saline nose washes get a big thumbs up from the ENTs, as do as over-the-counter pain medications. The saline washes out mucus and reduces stuffiness, and also improves the health of membranes, Rosenfeld says.

Steroid nose sprays may help with inflammation, the guidelines say, especially for people with chronic sinusitis, which lasts more than three months.

Chronic sinusitis shouldn't be diagnosed just on symptoms, the guidelines say; a doctor needs to document there's inflammation of the nose and sinuses, something that can be done by looking up the nose with various scopes.

"You can diagnose acute sinusitis from your armchair at home," Rosenfeld says. "But you can't diagnose chronic sinusitis." For that, at least, you need that doctor.

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To Avoid Surprise Insurance Bills, Tell Exchange Plan When You Move

NPR Health Blog - Wed, 04/01/2015 - 10:09am
To Avoid Surprise Insurance Bills, Tell Exchange Plan When You Move April 01, 201510:09 AM ET

Partner content from

Michelle Andrews

If you thought more experience with the heath insurance marketplaces would cut down on confusion about them, you'd be wrong. The questions about how they work keep pouring in. Here are answers to some of the latest queries.

I purchased health insurance in Ohio through the marketplace in April. I then moved to Missouri and applied for marketplace coverage there that began in October. I had assumed that the Ohio marketplace would cancel my coverage there, but that didn't happen. What should I do?

When people relocate, it's up to them to inform the marketplace and their insurer, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

If you don't inform the marketplace that you're cancelling your subsidized plan, a 90-day grace period will begin the first month that you don't pay your premium. The grace period is intended to protect consumers from losing coverage immediately because of a late payment. During the first 30 days, insurers are required to continue coverage and pay claims. For the next 60 days, if consumers still haven't paid up, insurers may delay paying claims. During this period, consumers can still pay their back premiums and continue their coverage if they wish. After 90 days, the insurer can cancel coverage.

You could be on the hook for the entire premium for the first month of the 90-day period, according to the Centers for Medicare & Medicaid Services. Although consumers wouldn't generally be responsible for repaying any premium tax credit for that first month, in some circumstances they might have to pay that back when they file their taxes, CMS says.

Solomon's advice: "Call the Ohio marketplace and ask them to retroactively cancel her coverage."

I help people apply for marketplace policies and I've noticed that some of the plans sold on the state marketplaces don't cover tobacco-cessation medication and other products for free as a preventive service. Isn't that required?

Under the health law, most health plans have to cover — without cost sharing by patients — preventive services that are recommended by the U.S. Preventive Services Task Force, a nonpartisan group of medical experts. The only exception is for plans that are grandfathered under the law.

The task force recommends that doctors ask patients whether they smoke and provide smokers with cessation interventions. Last May, the administration spelled out what would be covered: at least two stop-smoking attempts annually that include at least four counseling sessions and all tobacco-cessation medications (both prescription and over-the-counter options) that have been approved by the Food and Drug Administration.

Only 17 percent of insurers on the state marketplaces cover tobacco cessation medications without cost sharing, according to a report released Tuesday by the American Lung Association.

Stingy smoking cessation coverage is short-sighted, says Brian Hickey, director of federal government relations at The Campaign For Tobacco-Free Kids, an advocacy group.

"It's not overutilized and it's not particularly costly, especially when you consider its ability to reduce future medical costs," he says.

If a plan doesn't offer comprehensive coverage, Hickey recommends bringing it to the attention of the state insurance commissioner.

As a small employer, I believe that my employees may be better off if I dropped our group health plan and let them get coverage from the public exchanges. Is there any way for me to provide my employees pre-tax reimbursement for the premiums they pay on the exchanges?

No, that's not possible. As a small employer, you won't be fined if you don't offer health insurance on the job to your employees. In contrast, employers with 100 or more workers face penalties of up to $3,000 per worker for not offering good coverage and those with more than 50 employees will have the same penalties next year.

But no matter how many people you employ, you're not allowed to give workers cash for the purpose of buying their own policy on the exchange, according to published guidance from the Obama administration. That arrangement would count as a group health plan, and under the law those arrangements can't be integrated with individual exchange coverage.

However, as a small business owner, "you can always pay more in cash to the worker and the worker can take the cash and use it as he wants, whether to buy health insurance or for something else," says J.D. Piro, a senior vice president at Aon Hewitt, who leads the benefits consultant's health law group. As an employer, you just can't earmark that cash for health insurance.

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Tobacco Firm Seeks Softer Warning For Cigarette Alternative

NPR Health Blog - Wed, 04/01/2015 - 3:53am
Tobacco Firm Seeks Softer Warning For Cigarette Alternative April 01, 2015 3:53 AM ET Listen to the Story 4 min 50 sec  

Will this maker of snus, an alternative to cigarettes, be allowed to claim it is less harmful?

Swedish Match

The Food and Drug Administration is weighing whether to allow a tobacco company to do something it's never done before — claim that one of its products is less risky than cigarettes.

The company, Swedish Match of Stockholm, has applied to the FDA to designate its General brand of snus (rhymes with "loose") as safer than other versions of tobacco.

"Although there's evidence that snus may have reduced harm, reduced harm products are not the same as safe products."

Snus are tiny cloth packages that look a little like tea bags. But instead of tea, each bag is filled with moist tobacco powder. It comes in a variety of flavors. Snus is designed to give users another way to get nicotine and the taste of tobacco when they can't or don't want to smoke a cigarette or cigar.

Swedish Match wants the FDA to let the company remove most of the health warnings on its tins of snus (including a warning that the product increases a user's risk for mouth cancer or other tooth and gum problems), and change the label to say that snus is safer than cigarettes.

"What we're asking the FDA about is to allow us to inform the public with more truthful information about the health effects, because we believe that the health effects are clearly different than for most other products that are out there," says Lars Erik Rutqvist, the company's senior vice president for scientific affairs.

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He says snus doesn't increase the risk for any of the big problems caused by smoking, such as lung cancer and lung disease, because there's no smoke involved.

"Snus is at least 90 percent safer than cigarettes," Rutqvist says, "and there are some who claim that it's more than 99 percent less risky than cigarettes."

It's important that people know that, he says, because snus can help smokers kick their much riskier habits.

"There are a lot of smokers out there who are looking for less risky alternatives to their cigarettes, but who find it difficult to give up tobacco altogether," he says, noting that cigarette smoking decreased in Sweden as snus use increased.

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The tobacco industry has a long history of making misleading claims about the safety of its products. But some public health watchers of the tobacco industry say they are keeping an open mind about Swedish Match's request.

"This product appears to be less harmful than cigarette smoking," says Michael Eriksen, the dean of the Georgia State University School of Public Health. "And if that's established by the evidence that's presented to the FDA, then I think they should be able to say that in their advertising and in warning statements."

But many experts are also being cautious. Dr. Michael Steinberg, who directs the Tobacco Dependence Program at Rutgers University, says snus may be safer than cigarettes, but it's not totally safe.

"Although there's evidence that snus may have reduced harm," he says, "reduced harm products are not the same as safe products."

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Steinberg notes that snus contains nicotine, "which has physiologic risks in terms of raising heart rate, blood pressure etc." That could increase the risk for health problems such as strokes. There's also evidence snus may increase the risk for other health problems, such as pancreatic cancer.

Swedish Match questions that possible association and argues there's no evidence the product increases the risk for heart attacks or strokes.

Steinberg says another worry is that snus may end up helping smokers keep smoking by giving them kind of a crutch to get them through those times when they can't have a cigarette. And, Steinberg says, a change in the label could contribute to hooking a new generation on nicotine.

"If you imagine a young person who sees on a label that this is a less harmful tobacco product, they may interpret that as, 'Oh, this is not harmful at all. I might as well try it and see what it's all about,' " Steinberg says. "And that person can still become addicted to the nicotine effects, which could either lead to them becoming a long-term smokeless tobacco user, or could escalate to them starting to smoke cigarettes."

The FDA plans a two-day hearing, beginning April 9, to get advice about whether snus should become the first tobacco product that can officially claim it's safer than cigarettes.

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Tweeners Trust Peers More Than Adults When Judging Risks

NPR Health Blog - Tue, 03/31/2015 - 3:35pm
Tweeners Trust Peers More Than Adults When Judging Risks March 31, 2015 3:35 PM ET

Jump off a roof? Ride a bike while texting? Well, what do you think?


If you are the parent of a preteen, you are all too aware that they suddenly seem to value the opinions of their peers far more than yours.

The good news, if there is any, is that you're not alone. Young teenagers ages 12 to 14 are more influenced by their peers' opinions than they are by adults', a study finds. That's true only for that age group, not for older teens, children or adults.

Researchers asked 563 people visiting the London Science Museum to rate the riskiness of activities like crossing the street on a red light, biking without a helmet, or bungee jumping. The study was published last week in Psychological Science.

Then they were told how other groups rated the risk, and asked to rate them again. Everyone's ratings changed based on what they were told. That's no surprise; decades of study has shown that we're all swayed by social influences.

But what's fascinating here is that only one age group paid more attention what their peers thought than what adults thought — the tweeners.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-adolescent-influence-20150330', '', {} ); });

"Adolescents are always more risk-taking than other groups," Lisa Knoll, a post-doctorate researcher in cognitive neuroscience at University College London and lead author of the study, told Shots. And they tend to take more risks when they're with other teens.

It's not clear why the young teens would suddenly pay more attention to their peers, Knoll says. She's doing further experiments with brain scans to see if it might be linked to adolescent brain development.

But for now, she can say there's a clear difference in perception for that age group. And they know it.

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She usually calls study participants after the fact and explains what she found.

"I asked them whether they think that's the case and whether they are surprised. Usually they're not surprised. They know that older people have more experience in these kinds of situations, but they say, 'Well, I'm a teenager.' Even teenagers have this stereotypical idea of how to be a teenager. And that's why they tend maybe to follow their age group in their behavior."

OK, so they're not listening to the adults when evaluating risks. Should parents be even more worried than they are now?

"If I were you I would not worry that you somehow lose control of your child," Knoll says. "A lot of studies suggest that teenagers still really trust the judgement of their parents, and they ask them for advice in major decisionmaking."

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Hackers Teach Computers To Tell Healthy And Sick Brain Cells Apart

NPR Health Blog - Tue, 03/31/2015 - 2:36pm
Hackers Teach Computers To Tell Healthy And Sick Brain Cells Apart March 31, 2015 2:36 PM ET Listen to the Story 2 min 41 sec  

The Allen Institute for Brain Science hosted its first BigNeuron Hackathon in Beijing earlier this month. Similar events are planned for the U.S. and U.K.

Courtesy of Allen Institute for Brain Science

Brain researchers are joining forces with computer hackers to tackle a big challenge in neuroscience: teaching computers how to tell a healthy neuron from a sick one.

"Sick neurons have a withered appearance, much like a sick plant has a withered appearance," says Jane Roskams, an executive director at the Allen Institute for Brain Science. But at the moment, she says, highly trained scientists are still better than computers at assessing a neuron just by looking at its shape, which resembles a tree that can have thousands of branches.

"We should be able to then look within an aging brain and go, 'Wow, that's why that person is so sharp and sprightly. Their neuron in this part of their brain looks exactly the same as a 20-year-old's.' "

Automating the analysis of single neurons could greatly speed up the process, allowing analysis of thousands of cells. A standardized, computer-based system also would make it easier for researchers to compare results and allow more labs to study how the shape of neurons is changed by everything from learning to Alzheimer's disease, Roskams says.

A 3-D reconstruction of a healthy auditory neuron from a chick.

Courtesy of Allen Institute for Brain Science

So the institute has launched BigNeuron, a collaborative effort to improve the computer algorithms that turn microscope images of a neuron into a three-dimensional digital model and then analyze its shape. The effort will include a series of hackathons in which programmers and brain scientists get together to test their algorithms.

"So we have 15 to 20 people in a room," Roskams says. "They each have their pet algorithm, and they're kind of racing each other." The first hackathon took place in Beijing in mid-March. Others are planned for the U.S. and the U.K.

At each event, participants are given access to supercomputers and high-quality images of many different kinds of neurons. The goal is to find the best algorithms. And those won't necessarily come from people who know a lot about the brain, Roskams says.

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"We have incredibly talented young people who can code and program and begin to give meaning to some of the pictures that we've been taking in a way that many neuroscientists can't imagine doing," she says.

Shots - Health News Power To The Health Data Geeks

The algorithms that emerge will be shared with scientists and even students around the world. Giving more people the ability to study neurons could help answer fundamental questions, like how the shape of a neuron changes throughout a person's lifetime, Roskams says.

"We should be able to look within an aging brain and go, "Wow, that's why that person is so sharp and sprightly. Their neuron in this part of their brain looks exactly the same as a 20-year-old's," Roskams says.

Today, analyzing the complex shape of a neuron often requires a supercomputer. But one long-term goal of BigNeuron, Roskams says, is to create programs that a high school student could use on a laptop computer.

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Meet The Bacteria That Make A Stink In Your Pits

NPR Health Blog - Tue, 03/31/2015 - 11:19am
Meet The Bacteria That Make A Stink In Your Pits March 31, 201511:19 AM ET Poncie Rutsch

While you're resting, your armpit bacteria are hard at work pumping out stinky thioalcohols.


The human armpit has a lot to offer bacteria. It's moist, it's warm, and it's usually dark.

But when the bacteria show up, they can make a stink. That's because when some kinds of bacteria encounter sweat they produce smelly compounds, transforming the armpit from a neutral oasis to the mothership of body odor. And one group of bacteria is to blame for the stink, researchers say.

The researchers took bacteria commonly found in the armpit and added an odorless molecule found in human sweat. "These odorless molecules come out from the underarm, they interact with the active microbiota, [and] they're broken down inside the bacteria," explains Dan Bawdon, a postdoctoral researcher at the University of York in England, who led the study.

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When the bacteria break down the sweat they form products called thioalcohols, which have scents comparable to sulfur, onions or meat. "They're very very pungent," says Bawdon. "We work with them at relatively low concentrations so they don't escape into the whole of the lab but ... yes, they do smell. So we're not that popular."

The thioalcohol molecules evaporate from the underarm, which is what makes the armpit smelly. So Bawdon and his advisor Gavin Thomas, a senior lecturer in microbiology at the University of York, measured how much thioalcohol each bacteria species produced. In the end, they could point to Staphylococcus hominis as one of the worst offenders. They announced their findings Monday at the Society for General Microbiology's annual conference in Birmingham, England.

The two researchers are hoping that their findings will change the way that we engineer deodorants fight body odor. Most deodorants block sweat glands or kill off underarm bacteria. Blocking the sweat glands sometimes leads to irritated or swollen skin. And given all the new research into the complexity of the human microbiome, the researchers are a little anxious that deodorants may kill good bacteria, too.

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It's hard to say whether the bacteria in the armpit are helping the human body the way that gut bacteria or skin bacteria do. "But it kind of makes sense to not kill everything," says Thomas. "As we know from antibiotics, if we can design something specific that's probably going to be a more sensible approach."

He and Bawdon envision a deodorant that would keep armpit bacteria from producing thioalcohols. They borrowed their bacteria from Unilever, a company in the Netherlands and the United Kingdom that produces personal care products. The company provided a small amount of funding so that it can use the research results to make next-generation deodorants.

But before such a deodorant shows up on the shelf, the researchers need to make sure that there aren't other smelly processes taking place in the armpit. There may be other molecules that make the armpit smelly, and the researchers haven't yet finished their quest to describe them all.

"It's an extremely exciting time to be a microbiologist," Thomas says. Of those many denizens of the armpit, he says, "We haven't yet really figured out why they're there and exactly what they're all doing."

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No Easy, Reliable Way To Screen For Suicide

NPR Health Blog - Tue, 03/31/2015 - 4:58am
No Easy, Reliable Way To Screen For Suicide March 31, 2015 4:58 AM ET Listen to the Story 4 min 9 sec  

About twice a year, statistics suggest, a pilot somewhere in the world — usually flying alone — deliberately crashes a plane. The Germanwing flight downed last week may be one such case. But most people who fit the psychological profile of the pilots in these very rare events never have problems while flying.

Patrik Stollarz/AFP/Getty Images

Even a careful psychiatric examination of the co-pilot involved in last week's Germanwings jetliner crash probably would not have revealed whether he intended to kill himself, researchers say.

"People are often motivated to deny or conceal thoughts about suicide for fear of being intervened upon or locked in a psychiatric hospital against their will."

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"As a field, we're not very good at accurately predicting who is at risk for suicidal behavior," says Matthew Nock, a psychology professor at Harvard. He says studies show that mental health professionals "perform no better than chance" when it comes to predicting which patients will attempt suicide.

Nock made the comments after German authorities said that the co-pilot, Andreas Lubitz, had once received treatment for suicidal tendencies. Lubitz is suspected of deliberately crashing the Germanwings plane into the French Alps, killing 150 people onboard.

Most of what scientists know about suicide comes from studies of the general population, not pilots, says Guohua Li, who directs the Center for Injury Epidemiology and Prevention at Columbia University. Only one or two pilots a year kill themselves by crashing an airplane, he says, and they are nearly always general aviation pilots flying alone.

Li was a coauthor of a study in 2005 that looked at several dozen pilot suicides. It found many of them fit a profile: young, male, with a history of mental health problems and relationship problems. That profile appears to fit the Germanwings pilot "very, very well," Li says.

But the profile also fits thousands of pilots who will never have any problems while flying, Li says. "There is no reliable way for any airline to predict which pilots are going to commit suicide by airplane," he says.

Airlines could improve safety by aggressively screening pilots for alcohol and illicit drug use, Li says. The U.S. does this, but most other countries do not, he says.

One reason mental health professionals often get it wrong when it comes to suicide is that they know only what people are willing to tell them, says Nock. "People are often motivated to deny or conceal thoughts about suicide for fear of being intervened upon or locked in a psychiatric hospital against their will," he says.

Other motivations include fear of being stigmatized or losing a job. But even people who are already in a psychiatric hospital rarely reveal their intentions, Nock says. About "78 percent of people who die by suicide in the hospital explicitly denied suicidal thoughts or intentions in their last interview before dying," he says, sometimes because they lack insight into their own state of mind.

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So Nock has been experimenting with tests that are harder to fool. One involves simply indicating the color of words as they appear on a computer screen. Participants push one button for red words and another for blue words, while the computer measures their reaction time.

"If you're thinking about suicide, seeing the word suicide or death interferes with your ability to respond and it takes you just a few milliseconds longer to respond," Nock says. That's probably because the person has an involuntary emotional reaction to the word that slows him down, he explains.

Tests like that can greatly improve predictions about what a person is going to do, Nock says. But they are still experimental and still don't reveal precisely when someone will act.

"To date we've followed people over a six-month period," he says. "What we need to get better at is who's at risk of suicidal behavior imminently, in the next hours or days or even week. And that's where we still have a lot of work to be done."

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Why Are More Baby Boys Born Than Girls?

NPR Health Blog - Mon, 03/30/2015 - 3:08pm
Why Are More Baby Boys Born Than Girls? March 30, 2015 3:08 PM ET Listen to the Story 3 min 13 sec  

There's a widely held assumption that a slight imbalance in male births has its start at the very moment of conception. But researchers say factors later in pregnancy are more likely to explain the phenomenon.

CNRI/Science Source

Scientists have found some unexpected clues that could help explain why 51 percent of the babies born in the United States are male.

It's been a mystery why that ratio isn't 50:50, since that's what basic biology would predict. But scientists have noticed a tilted sex ratio at birth since the 17th century.

The widely held assumption is that this imbalance starts at the very moment of conception — that more males are conceived than females.

"There were a number of people who said, hold on, we don't have much business saying anything about the sex ratio at conception," says biologist Steven Orzack at the Fresh Pond Research Institute in Cambridge, Mass. "But for the most part people didn't listen to them."

Orzack, along with colleagues from Harvard, Oxford and Genzyme Genetics, decided to dig into this question. They collected information from more than 140,000 embryos that had been created in fertility clinics, along with almost 900,000 samples from fetal screening tests like amniocentesis and 30 million records from abortions, miscarriages and live births. Most of these data came from the U.S. and Canada, not countries like China, where parents more often abort female fetuses.

"It's the largest compilation of data for this kind of investigation that's ever been put together," Orzack says.

And they now report in the Proceedings of the National Academy of Sciences that they did not see the long-assumed difference between male and female embryos at the time of conception.

"The best estimate we have is that it's even-steven — 50 percent males [and] 50 percent females," Orzack says.

So that must mean the skewed sex ratio at birth happens during pregnancy. Looking deeper, the researchers found that in the very first week of pregnancy, more male embryos died, possibly as a result of serious chromosomal abnormalities, which they also documented.

"When that settles out, it looks like there starts to be an excess of female mortality," Orzack says. "And in the third trimester, as has been known for a long time, there is a slight excess of male mortality."

When you put this all together, it turns out more males are born because more female fetuses are lost during pregnancy.

"That's completely opposite to what had been believed for a long time," Orzack says.

Explaining why more boys are born than girls is, of course, a catchy result. "It's always sexy to talk about sex," says Dr. Eugene Pergament, an obstetrics researcher at Northwestern University.

But he says the research's greatest contribution is that it sheds light on what's going on during early pregnancy. That's a time when scientists have very little understanding of what's happening within a developing embryo, and what external influences may be affecting its development and survival.

"I think it will eventually have greater consequences and significance in our understanding normal and abnormal human development," Pergament says.

Orzack says he's hoping all sorts of researchers can now turn his observations into insight.

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Doctors With Cancer Push California To Allow Aid In Dying

NPR Health Blog - Mon, 03/30/2015 - 12:23pm
Doctors With Cancer Push California To Allow Aid In Dying March 30, 201512:23 PM ET

Partner content from

Anna Gorman

Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer.

Anna Gorman/KHN

Dan Swangard knows what death looks like.

As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety. He has watched death drag on for weeks or months as terrified relatives stand by helplessly.

Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.

To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder. The operation was successful, but Swangard, 48, knows there's a strong chance the disease will return. And if he gets to a point where there's nothing more medicine can do, he wants to be able to control when and how his life ends.

"It's very real for me. This could be my own issue a year from now."

"It's very real for me," said Swangard, who lives in Bolinas, Calif. "This could be my own issue a year from now."

That's one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard says, he can't say for certain whether he would take them.

"But I want to be able to make that choice," he said.

The right-to-die movement has gained renewed momentum in California and around the nation following the highly publicized death of Brittany Maynard. The 29-year-old with brain cancer moved from California to Oregon to take advantage of its "Death with Dignity" law and died in November after taking a fatal dose of barbiturates prescribed by her doctor.

The California lawsuit asks the court to protect physicians from liability if they prescribe lethal medications to patients who are both terminally ill and mentally competent to decide their fate.

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The lawsuit argues that while it is against the law in California for anyone to assist in another's suicide, these cases are not suicides. Rather, the suit argues, they are choices by a dying person on how his or her life should end and decisions about one's own body protected under the state constitution.

Separately, two California state senators have proposed a bill that would allow doctors to prescribe lethal medication to certain terminally ill adults.

Three states — Oregon, Washington and Vermont — already have laws allowing physician-assisted deaths. Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was recently filed in New York.

Legislation is pending in several other states. Kathryn Tucker, an attorney on several of the court cases, is spearheading the California lawsuit. This time, she and her legal team decided to include among the plaintiffs two doctors with life-threatening illnesses, Swangard and a retired San Francisco obstetrician.

Physicians "have a very deep and broad understanding about what the journey to death can be like," said Tucker, executive director of the Disability Rights Legal Center. "The curtain is pulled back. For lay people, death is much more mysterious."

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Historically, doctors have been some of the most vocal critics of assisted suicide, also called aid in dying. The American Medical Association still says that "physician-assisted suicide is fundamentally incompatible with the physician's role as healer." Similarly, the California Medical Association takes the view that helping patients die conflicts with doctors' commitment to do no harm. "It is the physicians' job to take care of the patient and that is amplified when that patient is most sick," said spokeswoman Molly Weedn.

But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier.

Swangard is among those who believe that taking care of patients means letting them choose how their lives should end. That's not the same as killing patients or facilitating suicide, he said.

Swangard completed his medical residency in San Francisco in the middle of the AIDS crisis; young men were dying all around him. Throughout his career as an internal medicine doctor, a hospice volunteer and now an anesthesiologist, he has become frustrated with the way the medical system handles death. Doctors spend so much time trying to extend life that few focus on what patients want in their last days, he said.

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"I don't think we know how to die," he said. "We fight tooth and nail to keep that from happening."

Swangard's own illness was discovered in early 2013 during a long overdue checkup. He hadn't been worried about his health — he was obsessed with fitness, swimming regularly and seeing a trainer twice a week. But when the doctor pressed on Swangard's stomach, he felt a mango-size mass.

He had a visceral feeling, he said, "something bad was happening."

Within a week, a surgeon found a neuroendocrine tumor in the pancreas and metastasis in the liver. It was the same cancer that took Steve Jobs' life — one that doesn't generally respond to chemotherapy or radiation. "My fears became real," Swangard said.

The doctors told him they believed they got all the cancerous cells. But Swangard was tormented by questions: Am I going to be alive in a year? Is my cancer going to come back?

"I wasn't sleeping, I wasn't exercising, I was marinating in my own sadness and fear of what this all meant," he said. "I thought, 'This is going to kill me.' "

"It is a little bit of a blessing to know how I might die. I don't think a lot of patients have insight into what to expect."

Since his diagnosis, Swangard said he has had a greater understanding of his patients' struggles. Occasionally, he holds their hands and tells them he has been where they are.

Earlier this year, a physician friend asked him if he'd be willing to join the California case. Swangard didn't hesitate. He didn't go into medicine to help dying people linger and wants to help change that approach — for his patients and for himself.

When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn't want to be in a drug-induced haze, nor consumed by worry about what's next. He wants to be able to say goodbye.

"It is a little bit of a blessing to know how I might die," he said. "I don't think a lot of patients have insight into what to expect."

These days, he wears a Buddhist prayer bracelet, a reminder to focus on the present. He cut his work hours, swims as often as he can and meditates regularly. At home, he stares out at the ocean, often watching dolphins pass by. He makes every effort to stay calm and healthy.

He is in remission, but he knows that what happens with the cancer is largely outside his control. MRI last year showed a small lesion in his liver, which doctors are watching closely.

"It's this big unknown," he said.

Dr. Robert Liner, a fellow plaintiff who only recently met Swangard, lives with the same uncertainty.

Retired San Francisco obstetrician Robert Liner, 70, is a plaintiff in a California lawsuit seeking to let doctors prescribe lethal medications to certain patients who want to die.

Ana Gorman/KHN

On his 69th birthday in May 2013, the retired obstetrician had a bad cough. He felt tired and short of breath. His wife took him to the hospital, where doctors discovered malignant masses on his kidneys — advanced-stage lymphoma.

After radiation and chemotherapy, the tumors shrank. He also is in remission. But if the cancer comes back, he said, "The prospects are not going to be good."

He often thinks of a former patient, a 25-year-old woman with metastatic ovarian cancer. She wanted to die while she still was able to communicate. Liner wasn't able to help ease her death because the law wouldn't let him. "I felt like I'd failed her," he said.

Years before his diagnosis, Liner, now 70, became involved with Compassion & Choices, an organization that promotes aid in dying. He has a shelf of books in his San Francisco home devoted to the subject: Being Mortal, Dying Right, Knocking on Heaven's Door.

Liner keeps a stack of notecards with quotes about the end of life, which he often recites in speeches to church groups or senior centers. One reads, "The best preparation for death is a life well-lived."

He believes having medication to hasten death helps terminally ill people live fully in their last weeks or months without being immobilized by fear. "If you are riddled with anxiety, you are not free to concentrate on what's most meaningful to you," he said.

Like Swangard, Liner doesn't know if he would take the medication. He recently married the woman he calls his "beloved" and said he has lots of plans for his retirement years, including writing a screenplay and improving his piano playing.

"My wife says I'd be hanging on to life by my fingernails," he said.

But that decision should be his to make, with his family and his doctor, he said. "I want the comfort of knowing it's up to me when enough is enough," he said.

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Sure, Use A Treadmill Desk — But You Still Need To Exercise

NPR Health Blog - Mon, 03/30/2015 - 3:40am
Sure, Use A Treadmill Desk — But You Still Need To Exercise March 30, 2015 3:40 AM ET Listen to the Story 3 min 25 sec  

NPR senior Washington editor Beth Donovan walks on a treadmill desk in her office in Washington, D.C.

Meredith Rizzo/NPR

First off, I need to be upfront: I have a treadmill desk. I got it about two years ago, prompted by all the studies showing the dangers of sitting all day. The idea is to get people more active and walking while working. The problem is, I don't use it. In fact, I probably only used it for a few months. I still stand all day, but I'm not walking.

It turns out I'm not alone. Treadmill desks may have seen their day, according to Dr. Tim Church of the Pennington Biomedical Research Center in Baton Rouge, La. Church specializes in preventive medicine and works with companies to promote healthy activities on the job. A few years ago the treadmill desk "had a cool toy element to it," he says. "Everybody wanted one, and then when a lot of people got them they just didn't use them that much."

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And there's not a lot of evidence showing the benefit — or not — of using a treadmill desk. A recent small study, just 41 people, looked at whether the desks helped overweight and obese people get more active. The participants worked at a large insurance company and pretty much sat all day. Half the employees were given treadmill desks and were asked to walk on them twice a day at a leisurely pace for about 45 minutes.

But the participants didn't use the treadmills as much as they were asked, according to John Schuna, an assistant professor of exercise and sports science at Oregon State University and one of the study's authors. They averaged just one 45-minute session a day instead of two. And when they did use the treadmill, they didn't burn enough calories to lose weight — their pace was too slow.

Maura Howard tries to log about 3 miles a day on a treadmill desk at Salo, a financial staffing company in Minneapolis. She says regular walking helps her avoid after-lunch drowsiness.

Richard Sennott/MCT/Landov

Federal guidelines recommend 150 minutes of moderate to vigorous physical activity every week. That's walking about 3 miles per hour. Schuna says that's difficult on a treadmill desk — while working. If you tried to maintain that pace, "you'd likely start to perspire; some people may even start to have more labored or heavy breathing," he says, and "it's questionable how productive you could be from a work perspective."

But don't be too quick to write off the treadmill desk, which costs about $1,000 to $1,500. Study participants did increase the average number of steps they took in a day by about 1,000, and Schuna says, "Something is better than nothing."

If they had done a second 45-minute session or if the study had gone on longer, say six months, there may have been some weight loss, he adds. And as long as you're accumulating some physical activity, "you're still potentially gaining more health benefit than if you're sedentary all day."

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And there are a couple of small studies that do suggest some benefit. One study, headed by Dr. James Levine, an endocrinologist at the Mayo Clinic's campus in Scottsdale, Ariz., found that over a 12-month period participants using treadmill desks increased their daily activity and lost weight.

Levine conducted another small study in 2007 at Salo, a finance, accounting and human resources staffing company in Minneapolis. This also was a very small study, just 18 people. For six months they rotated on and off treadmill desks, walking on average about three hours a day. Everyone lost weight and there were other health benefits, including lower cholesterol and triglycerides.

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Salo's marketing director, Maureen Sullivan, says the desks are still going strong. "I will get on if I'm on a conference call for an hour at a time," she says. "There are people in our office who are on between one to four hours, either every day or every other day."

One reason the desks remain so popular, she says, is that the company was founded on principles of healthy well-being and works hard to keep that spirit throughout the day. "We have a culture of movement," Sullivan says. There's a game room, walking meetings and a "contagious" atmosphere of high energy.

But the positive benefits found in the Salo study have yet to be reproduced in larger, long-term studies elsewhere. Until then, the bottom line seems to be, if you have a treadmill desk — use it. But don't forget you still have to fit about 150 minutes of moderate to vigorous exercise into your weekly routine as well.

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